Miscarriage and ectopic pregnancy may trigger long-term post-traumatic stress, anxiety and depression

January 15 2020

According to a study published by Tommy’s National Centre for Miscarriage Research, 1 in 6 women experience long-term post-traumatic stress following miscarriage or ectopic pregnancy.

This is the finding of the largest ever study into the psychological impact of early-stage pregnancy loss, from scientists at Imperial College London and KU Leuven in Belgium.

Post-traumatic stress disorder (PTSD) after early pregnancy loss

The research, published in the American Journal of Obstetrics and Gynaecology, studied 737 women who had experienced an early pregnancy loss, with the majority having an early miscarriage or an ectopic pregnancy.

The study revealed that 1 month following pregnancy loss, nearly a third of women suffered post-traumatic stress while 1 in 4 experienced moderate to severe anxiety.

The team behind the research, funded by the Imperial Health Charity and the Imperial NIHR Biomedical Research Centre, call for immediate improvements in the care women receive following an early-stage pregnancy loss. 

“Pregnancy loss affects up to 1 in 4 women, and for many women it will be the most traumatic event in their life. This research suggests the loss of a longed-for child can leave a lasting legacy and result in a woman still suffering post-traumatic stress nearly a year after her pregnancy loss.

“The treatment women receive following early pregnancy loss must change to reflect its psychological impact, and recent efforts to encourage people to talk more openly about this very common issue are a step in the right direction. Whilst general support and counselling will help many women, those with significant post-traumatic stress symptoms require specific treatment if they are going to recover fully. This is not widely available, and we need to consider screening women following an early pregnancy loss so we can identify.”

Professor Tom Bourne, lead author of the research from Tommy’s National Centre for Miscarriage Research at Imperial College London

More about the study 

The research follows an earlier pilot study in 2016, which investigated the psychological impact of early-stage pregnancy loss in 128 women 1 and 3 months after miscarriage or ectopic pregnancy. Estimates suggest there are 250,000 miscarriages every year in the UK, and around 11,000 emergency admissions for ectopic pregnancies. Ectopic pregnancies always result in pregnancy loss, as an embryo grows in an area outside of the womb and is unable to develop.

The women in the study attended the Early Pregnancy Assessment Units at 3 London hospitals - Queen Charlottes and Chelsea, St Mary’s, and Chelsea and Westminster. All were asked to complete questionnaires about their emotions and behaviour 1 month after pregnancy loss, then again 3 and 9 months later

Their responses were compared to 171 women who had healthy pregnancies. The results revealed that women who had suffered early pregnancy loss experienced increased psychological symptoms, compared to those who had healthy pregnancies.

The women in the study who met the criteria for post-traumatic stress reported regularly re-experiencing the feelings associated with the pregnancy loss and suffering intrusive or unwanted thoughts about their miscarriage. Some women also reported having nightmares or flashbacks, while others avoided anything that might remind them of their loss.

The authors note that the study used a questionnaire to screen for post-traumatic stress, but formal diagnosis of post-traumatic stress disorder would require a clinical interview. The team also explain that women who were already experiencing symptoms of post-traumatic stress and depression may have been more likely to respond to the questionnaire, which could mean the number of women suffering psychological symptoms may appear higher.

The long-lasting effects of PTSD

 “The effects of post-traumatic stress can have a toxic effect on all elements of a person’s life – affecting work, home and relationships. We have made significant progress in recent years in breaking the silence around mental health issues in pregnancy and postnatally, but early pregnancy losses are still shrouded in secrecy, with very little acknowledgement of how distressing and profound an event they are.

“Many women don’t tell colleagues, friends or family they are pregnant before the 12-week scan, leaving them feeling unable to discuss their emotions if they suffer a pregnancy loss. We also know partners can suffer psychological distress following miscarriage or ectopic pregnancy and are investigating this in ongoing research.”

Dr Jessica Farren, author of the research from Imperial College and Obstetrician and Gynaecologist

The team’s research will also now focus on identifying which women are at risk of developing psychological symptoms after pregnancy loss, and also the best type of treatments and how to deliver these.

“For too long women have not received the care they need following a miscarriage and this research shows the scale of the problem. Miscarriage services need to be changed to ensure they are available to everyone and women are followed up to assess their mental wellbeing with support being offered to those who need it and advice is routinely given to prepare for a subsequent pregnancy.”

Jane Brewin, Chief Executive of Tommy’s

Read more about Tommy's research into miscarriage